Mediation analysis of the relationship between type 2 diabetes and cardiovascular events and all-cause mortality: Findings from the SMART cohort
SMART Study Group
(2019) Diabetes, Obesity & Metabolism, volume 21, issue 8, pp. 1935 - 1943
(Article)
Abstract
Aim: To quantify the magnitude and specific contributions of known cardiovascular risk factors leading to higher cardiovascular risk and all-cause mortality caused by type 2 diabetes (T2D). Methods: Mediation analysis was performed to assess the relative contributions of known classical risk factors for vascular disease in T2D (insulin resistance, systolic
... read more
blood pressure, renal function, LDL-cholesterol, triglycerides and micro-albuminuria), and what proportion of the effect of T2D on cardiovascular events and all-cause mortality these factors mediate in the Second Manifestations of ARTerial disease (SMART) cohort consisting of 1910 T2D patients. Results: Only 35% (95% CI 15-71%) of the excess cardiovascular risk caused by T2D is mediated by the classical cardiovascular risk factors. The largest mediated effect was through insulin resistance [proportion of mediated effect (PME) 18%, 95% CI 3-37%], followed by elevated triglycerides (PME 8%, 95% CI 4-14%) and micro-albuminuria (PME 7%, 95% CI 3-17%). Only 42% (95% CI 18-73%) of the excess mortality risk was mediated by the classical risk factors considered. The largest mediated effect was by micro-albuminuria (PME 18%, 95% CI 10-29%) followed by insulin resistance (PME 15%, 95% CI 1-33%). Conclusion: A substantial amount of the increased cardiovascular risk and all-cause mortality caused by T2D cannot be explained by traditional vascular risk factors. Future research should focus on identifying non-classical pathways that might further explain the increased cardiovascular and mortality risk caused by T2D.
show less
Download/Full Text
Keywords: cardiovascular risk, mediation analysis, risk factors, type 2 diabetes, Endocrinology, Internal Medicine, Endocrinology, Diabetes and Metabolism, Journal Article
ISSN: 1462-8902
Publisher: Wiley-Blackwell
Note: Funding Information: We gratefully acknowledge the contribution of the SMART research nurses; R. van Petersen (data-manager); B.G.F. Dinther (vascular manager) and the participants of the SMART Study Group: A. Algra MD, PhD; Y. van der Graaf, MD, PhD; D.E. Grobbee, MD, PhD; G.E.H.M. Rutten, MD, PhD, Julius Center for Health Sciences and Primary care; F.L.J. Visseren, MD, PhD, Department of Internal Medicine; G.J. de Borst, MD, PhD, Department of Vascular Surgery; L.J. Kappelle, MD, PhD, Department of Neurology; T. Leiner, MD, PhD, Department of Radiology; H.M. Nathoe, MD, PhD, Department of Cardiology. Publisher Copyright: © 2019 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.
(Peer reviewed)